EP1604615A1 - MRI biopsy device - Google Patents
MRI biopsy device Download PDFInfo
- Publication number
- EP1604615A1 EP1604615A1 EP05253171A EP05253171A EP1604615A1 EP 1604615 A1 EP1604615 A1 EP 1604615A1 EP 05253171 A EP05253171 A EP 05253171A EP 05253171 A EP05253171 A EP 05253171A EP 1604615 A1 EP1604615 A1 EP 1604615A1
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- European Patent Office
- Prior art keywords
- sleeve
- depth
- penetration
- mount
- biopsy device
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- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/02—Instruments for taking cell samples or for biopsy
- A61B10/0233—Pointed or sharp biopsy instruments
- A61B10/0266—Pointed or sharp biopsy instruments means for severing sample
- A61B10/0275—Pointed or sharp biopsy instruments means for severing sample with sample notch, e.g. on the side of inner stylet
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
- A61B90/17—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins for soft tissue, e.g. breast-holding devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/02—Instruments for taking cell samples or for biopsy
- A61B2010/0208—Biopsy devices with actuators, e.g. with triggered spring mechanisms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00796—Breast surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00796—Breast surgery
- A61B2017/008—Removal of tumors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
- A61B2017/3405—Needle locating or guiding means using mechanical guide means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/347—Locking means, e.g. for locking instrument in cannula
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
- A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3954—Markers, e.g. radio-opaque or breast lesions markers magnetic, e.g. NMR or MRI
Definitions
- the present invention relates, in general, to a method of imaging assisted tissue sampling and, more particularly, to an improved method for positioning a biopsy probe with respect to a magnetic resonance imaging (MRI) breast coil for acquiring subcutaneous biopsies and for removing lesions.
- MRI magnetic resonance imaging
- the instrument is a type of image-guided, percutaneous coring, breast biopsy instrument. It is vacuum-assisted, and some of the steps for retrieving the tissue samples have been automated. The physician uses this device to capture "actively" (using the vacuum) the tissue prior to severing it from the body. This allows the sampling of tissues of varying hardness.
- a side opening aperture is used, avoiding having to thrust into a lesion, which may tend to push the mass away, cause a track metastasis, or cause a hematoma that, with residual contrast agent circulating therein, may mimic enhancement in a suspicious lesion.
- the side aperture may be rotated about a longitudinal axis of the probe, thereby allowing multiple tissue samples without having to otherwise reposition the probe.
- localization fixtures are described that are attachable to a breast coil. These localization fixtures aid in accurately positioning the probe to a location of a suspicious lesion within breast tissue.
- the X-Y-Z Cartesian coordinates of a suspicious lesion are referenced to a fiduciary marker in the localization fixture.
- Humanly visible measurement guides for each axis then allow the probe to be correspondingly positioned after a patient has been withdrawn from a closed bore MRI machine without the need for imaging the probe during insertion.
- the localization fixture enables use of a detachable probe of an MRI biopsy device.
- a handle of the MRI biopsy device may be detached, as may be necessary within the close confines of a closed bore MRI machine.
- various support structures of the localization fixture are described that support the extended length of the handle.
- a localization fixture used with a detachable MRI biopsy probe has a number of advantages, it would be desirable to incorporate additional features that further assist in accurately positioning the probe, preventing over insertion or inadvertent retraction of the probe, and supporting the MRI biopsy device.
- the invention overcomes the above-noted and other deficiencies of the prior art by providing a localization and guidance assembly that interfaces an MRI biopsy device to a breast coil to accurately position and maintain a probe at a desired position in a patient's breast for performing biopsy and related diagnostic and therapeutic procedures, and especially for making a single insertion and taking multiple biopsy samples.
- a guide element is selectively positioned parallel to a desired axis of penetration into a patient.
- a mount movingly engages the guide element so that a penetrating portion of a biopsy instrument is supported along the axis of penetration during insertion into the patient.
- a depth limiting member, attached to a selected one of the mount and guide element, is advantageously adjusted prior to full insertion to arrest distal movement of the mount when the penetrating portion reaches a desired depth.
- a localization fixture compressively localizes a patient's breast, while a pedestal is laterally positioned to support the guide element, which is also vertically adjusted on the pedestal into parallel alignment with the desired axis of penetration.
- a method of guiding a penetrating portion of a biopsy device includes aligning a guide element parallel to and offset from a designated axis of penetration into a patient. Setting a depth limit for penetration prior to penetrating tissue assures that overshooting the intended target is avoided. Then slidingly engaging the penetrating portion of the biopsy device to the guide element effects penetration of the patient along the designated axis of penetration until arrested by the depth limit setting.
- FIGURE 1 is a perspective disassembled view of a Magnetic Resonance Imaging (MRI) biopsy system incorporating an elemental version of a guidance apparatus including a single targeting rail for positioning a probe depth-stop and guiding a biopsy device;
- MRI Magnetic Resonance Imaging
- FIGURE 2 is a disassembled perspective view of a localization fixture, and a depth stop and MRI biopsy device of the elemental version of the MRI biopsy system of FIG. 1;
- FIGURE 3 is a perspective view of a positioning pedestal and a single targeting rail of the elemental version of the MRI biopsy system of FIG. 1 after positioning of the depth stop and MRI biopsy device;
- FIGURE 4 is a perspective disassembled view of an alternative guidance assembly for the MRI biopsy system of FIG. 1, incorporating orthogonally targeting and biopsy support rails ("cradle");
- FIGURE 5 is a perspective view of a cradle engaging a depth stop second rail, depicted as locked, of another alternative guidance assembly for the MRI biopsy system of FIG. 1;
- FIGURE 5A is a perspective view of the depth stop second rail of FIG. 5, depicted as locked;
- FIGURE 5B is a proximal view in elevation of the cradle and depth stop second rail taken in cross section along lines 5B-5B of FIG. 5;
- FIGURE 5C is a top view of the depth stop second rail of FIG. 5 aligned for insertion into the cradle for insertion of a sleeve;
- FIGURE 5D is a top view of the depth stop second rail of FIG. 5C after insertion into the cradle;
- FIGURE 6 is a top view of an alternative depth guidance assembly with a flip monocle and a side lever that unlocks a sleeve block 470 for the MRI biopsy system of FIG. 1;
- FIGURE 7 is a top right perspective view of an additional depth guidance assembly with a knuckle mediated rough adjust for the MRI biopsy system of FIG. 1;
- FIGURE 8 is a left, proximal perspective view of a mediated knuckle and sleeve block with a guide tab and depth-stop second rail (screw) shown in phantom of the depth guidance assembly of FIG. 7;
- FIGURE 9 is a top, left, and distal perspective view of the depth guidance assembly of FIG. 7;
- FIGURE 10 is a top, proximal, perspective view of the depth guidance assembly of FIG. 7, distally adjusted for additional depth;
- FIGURE 10A is a top view of the depth guidance assembly of FIG. 10 in longitudinal cross section;
- FIGURE 11 is a top, proximal and right perspective view of another depth guidance assembly having rough adjust and release buttons shown detached from a primary targeting rail for the MRI biopsy system of FIG. 1;
- FIGURE 11A is a top view in longitudinal cross section of the depth guidance assembly with rough adjust and release buttons of FIG. 11 fully inserted into a targeting single rail;
- FIGURE 11B is a left, proximal and perspective view of a sleeve block cutaway along lines 11A-11A of the depth guidance assembly of FIG. 11;
- FIGURE 12 is a top, proximal and right perspective view of the depth guidance assembly of FIG. 11 after being partially inserted into the primary targeting rail;
- FIGURE 13 is a top, proximal and right perspective view of the depth guidance assembly of FIG. 11 after being fully inserted into the primary targeting rail;
- FIGURE 13A is a top view of the depth guidance assembly of FIG. 13 taken in cross section along lines 13A-13A;
- FIGURE 14 is a top, proximal and right perspective view of a telescoping depth guidance assembly with a sleeve and obturator for the MRI biopsy system of FIG. 1 engaged to a sleeve block;
- FIGURE 14A is a top view of the telescoping depth guidance assembly of FIG. 14 mounted in a targeting rail of the MRI biopsy system of FIG. 1;
- FIGURE 15 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 14 detached from a targeting rail and cradle;
- FIGURE 15A is a top view of the telescoping depth guidance assembly and targeting rail of FIG. 15;
- FIGURE 16 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 14 being guided by the targeting rail as the sleeve passes through a monocle on the cradle;
- FIGURE 16A is a top view of the telescoping depth guidance assembly of FIG. 16;
- FIGURE 17 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 16 after reaching a first targeted depth;
- FIGURE 17A is a top view of the telescoping guidance assembly of FIG. 17;
- FIGURE 18 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 17 after unscrewing the depth stop second rail;
- FIGURE 19 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 18 after distally inserting to the adjusted depth;
- FIGURE 20 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 19 after depressing a proximal lock release and partially extracting the depth guidance assembly from the targeting rail and cradle;
- FIGURE 21 is a top, proximal and right perspective view of an alternative primary targeting rail including a pawl recess for the MRI biopsy system of FIG. 1;
- FIGURE 22 is a perspective view of an alternative intermediate telescoping rail with a pawl in a second position
- FIGURE 23 is a perspective view of the alternative intermediate telescoping rail of FIG. 22, with a pawl in a third position, attached to the primary targeting rail of FIG. 21;
- FIGURE 23A is a perspective view of the alternative intermediate telescoping rail of FIG 22, with a pawl in a first position;
- FIGURE 24 is a right side view in elevation of a proximal portion of the intermediate telescoping rail of FIG. 23;
- FIGURE 24A is a top view of the proximal portion of the intermediate telescoping rail of FIG. 24 taken in cross section through the pawl, pawl recess of the primary targeting rail, and pawl aperture in the intermediate telescoping rail;
- FIGURE 25 is a perspective view of a sleeve block with locking tooth for the alternative intermediate telescoping rail of FIG. 22;
- FIGURE 26 is an aft view in elevation of the primary targeting rail and intermediate telescoping rail of FIG. 23;
- FIGURE 27 is a left side view in elevation of the proximal portion of the intermediate telescoping rail
- FIGURE 28 is a perspective view of a laterally guided biopsy cassette for the MRI biopsy system of FIG. 1;
- FIGURE 29 is a left side view in elevation of a disassembled laterally guided biopsy cassette of FIG. 28;
- FIGURE 28B is a left side view in elevation of the laterally guided biopsy cassette of FIG. 28 taken along a longitudinal centerline;
- FIGURE 28C is a top view of the laterally guided biopsy cassette of FIG. 28 taken along the longitudinal centerline;
- FIGURE 29A is a perspective view of the laterally guided biopsy cassette of FIG. 28 in an initial condition with the glide sleeve retracted over the plunger handle;
- FIGURE 29B is a perspective view of the laterally guided biopsy cassette of FIG. 29A after distally advancing the glide sleeve from the plunger handle;
- FIGURE 29C is a perspective view of the laterally guided biopsy cassette of FIG. 29B after depressing the release buttons and advancing a sleeve and obturator out of a plunger tube but within the confines of the glide sleeve;
- FIGURE 29D is a perspective view of the laterally guided biopsy cassette of FIG. 29C as the glide sleeve and an obturator guide are engaged to a targeting rail of a localization fixture;
- FIGURE 29E is a perspective view of the plunger tube being unlocked from the glide sleeve
- FIGURE 29F is a perspective view of the plunger tube being advanced into the glide sleeve, causing penetration of the sleeve and obturator, allowing thereafter retraction of the glide sleeve from the targeting rail;
- FIGURE 30A is a perspective view of an alternative biopsy cassette containing the depth guidance assembly with rough adjust and release buttons of FIG. 11 with a sleeve mounted thereto and an obturator retracted into a plunge tube of the alternative biopsy cassette;
- FIGURE 30B is a perspective view of the alternative biopsy cassette of FIG. 30A after a slide control is advanced on the plunge tube to insert the obturator into the sleeve;
- FIGURE 30C is a perspective view of the alternative biopsy cassette being engaged onto a targeting rail and cassette of a localization fixture
- FIGURE 30D is a perspective view of the alternative biopsy cassette fully engaged onto the targeting rail and cassette of a localization fixture.
- FIGURE 30E is a perspective of the alternative biopsy cassette removed from the targeting rail and cassette of a localization fixture leaving the depth guidance assembly thereon.
- a Magnetic Resonance Imaging (MRI) biopsy system 10 includes a guide element and an adjustable depth stop that assists a surgeon in inserting a biopsy probe along a desired trajectory without overshooting.
- a guide element is adjustably positioned to be parallel to an axis of penetration, which in turn is aimed to pass through an insertion point to a surgical site inside of the patient, typically where a suspicious lesion has been imaged.
- a depth stop is adjustably set to a desired penetration depth.
- a mount that supports at least the penetrating portion of the biopsy device is guided by the guide element as tissue of the patient is penetrated until the depth stop arrests further movement of the mount relative to the guide element.
- the MRI biopsy system 10 includes a control module 12 that typically is placed outside of a shielded room containing an MRI machine (not shown) or at least spaced away to mitigate detrimental interaction with its strong magnetic field and/or sensitive radio frequency (RF) signal detection antennas.
- the control module 12 controls and powers an MRI biopsy device 14 that is compatible for use in close proximity to the MRI machine.
- An example of an MRI biopsy device 14 is the afore-mentioned MAMMOTOMETM instrument.
- the MRI biopsy device 14 is accurately positioned by a localization fixture 16 that is attached to a breast coil 18, which in turn supports a patient (not shown).
- a guidance assembly 20 and in particular a sleeve 22, advantageously attaches to the localization fixture 16 to increase imaging and therapeutic flexibility and accuracy in conjunction with selective use of the MRI biopsy device 14 at particular parts of the procedure.
- the guidance assembly 20 may include one or more obturators 24 with one depicted that seals the sleeve 22 during insertion and during subsequent portions of the procedure in which the MRI biopsy device 14 is not inserted therein.
- a depth stop 26 is provided for use with the localization fixture 16 to advantageously prevent over-insertion of the sleeve 22, inadvertent retraction of the sleeve 22 and/or to enhance accurate placement of the sleeve 22 to a desired location along the Z-Axis.
- a perforated barrier that is compressed along an outside side of the breast, with respect to a medial plane of the chest of the patient, defines an X-Y plane, with the X-axis being vertical (sagittal) with respect to a standing patient and which corresponds to a left to right axis as viewed by a clinician facing the externally exposed portion of the localization fixture 16.
- a fiduciary marker (not shown) attached to or positioned relative to the localization fixture 16 proximate to the patient's skin defines the origin of this plane.
- Perpendicular to this X-Y plane extending toward the medial side of the breast is the Z-axis, which typically corresponds to the orientation and depth of insertion of the MRI biopsy device 14, although it should be appreciated that variations may allow insertion at an angle to this Z-axis.
- the term Z-axis may be used interchangeably with "axis of penetration", although the latter may or may not be orthogonal to the spatial coordinates used to locate an insertion point on the patient.
- Separating the tracking rail that supports a mount / depth stop from a biopsy rail that supports the weight of the biopsy device advantageously reduces interference between the various components, allowing a sequence of operation wherein certain components may be selectively installed and removed without interfering with other components.
- the MRI biopsy system 10 is prepared for use by placing a cable management spool 30 upon a cable management attachment saddle 32 that projects from a side of the control module 12. Wound upon the cable management spool 30 is a paired electrical cable 34 and mechanical cable 36 for communicating control signals and cutter rotation/advancement motions respectively.
- electrical and mechanical cables 34, 36 each have one end connected to respective electrical and mechanical ports 40, 42 in the control module 12 and another end connected to a holster 44 that receives the MRI biopsy device 14.
- An MRI docking cup 46 which may hold the holster 44 when not in use, is hooked to the control module 12 by a docking station mounting bracket 48.
- An interface lock box 50 mounted to a wall provides a tether 52 to a lockout port 54 on the control module 12.
- the tether 52 is advantageously uniquely terminated and of short length to preclude inadvertent positioning of the control module 12 too close to the MRI machine.
- An in-line enclosure 56 may advantageously register the tether 52, electrical cable 34 and mechanical cable 36 to their respective ports 54, 42, 44 on the control module 12.
- a remote keypad 58 may be distally connected to the electrical cable 34 to enhance clinician control of the MRI biopsy device 14, especially when controls on the MRI biopsy device 14 itself are not readily accessible after insertion into the localization fixture 16.
- Vacuum assist is provided by a first vacuum line 60 that connects between the control module 12 and an outlet port 62 of a vacuum canister 64 that catches liquid and solid debris.
- a tubing kit 66 completes the pneumatic communication between the control module 12 and the MRI biopsy device 14.
- a second vacuum line 68 is connected to an inlet port 70 of the vacuum canister 64.
- the second vacuum line 68 divides into two vacuum lines 72, 74 that are attached to the MRI biopsy device 14.
- the control module 12 performs a functional check. Saline is manually injected into biopsy device 14 to serve as a lubricant and to assist in achieving a vacuum seal.
- the control module 12 actuates a cutter mechanism (not shown) in the MRI biopsy device 14, monitoring full travel.
- the portion of the MRI biopsy system 10 used near the MRI machine is also assembled.
- the generally known breast coil 18 is placed upon a gantry of the MRI machine, along with other body support pads (not shown).
- the localization fixture 16 is also assembled with a disposable medial fence 90 and a lateral window (or perforated plate) 92.
- the base assembly 82 is placed within a selected lateral recess of the breast coil 18.
- the medial fence 90 attaches to a medial edge of the medial plate 80, aligned vertically approximately along a longitudinal axis of the breast coil 18 under an inner edge of a selected breast aperture 94 that receives a patient's breast.
- the lateral window 92 is downwardly slid into a three-sided frame guide 96 of the lateral assembly 84, which in turn is placed upon the medical plate 80.
- the base assembly 82 and lateral assembly 84 are moved with respect to one another along the Z-axis to compress the patient's breast between the medial fence 90 and the lateral window 92.
- a mechanism formed between the lateral assembly 84, base assembly 82, and medial plate 80 maintains this compression.
- Contrast agent may be injected into the patient to enhance the imaging.
- the gantry is advanced into the MRI machine bore to image the localization fixture 16 and breast tissue.
- the fiduciary marker on the lateral window 92 is located and designated as the origin of the X-Y-Z coordinates.
- a suspicious lesion is located within the image and a point thereon selected to determine its location relative to the origin. It should be appreciated that orienting the X-Y-Z axis of an initial scan may be facilitated by having the lateral window 92 formed of an imagable material, thus presenting an X-Y plane in addition to the origin point of the fiduciary marker. With the target location determined, the gantry is withdrawn from the MRI machine bore.
- the positioning pedestal 86 is slidably engaged along the X-axis of the lateral assembly 84 and defines a vertical guide for positioning a single targeting rail ("track") 98 at a selected Y-axis coordinate.
- the track 98 in turn provides a depth guide along the Z-axis for positioning the depth stop 26 and the holster 44 at a desired Z-axis coordinate.
- the depth stop 26 is latched onto the track 98. Thereafter, a marking instrument (not shown) may be inserted through the depth stop 26 to mark the insertion point on the breast. Thereafter, the depth stop 26 is moved out of the way. Anesthesia is injected superficially, following by a scoring cut at the marked location and a subsequent injection of anesthesia more deeply into the scored cut. The depth stop 26 is then repositioned on the track 98 to the desired Z-axis coordinate reference.
- the obturator 24 is inserted into the sleeve and may be positioned to close any apertures of the sleeve 22 (side and/or distal end) to present a closed surface to the breast tissue.
- the obturator may also be shaped or formed to enhance the visibility of the aperture location.
- One or the other of the obturator 24 and sleeve 22 presents a sharp tip (not shown) to penetrate breast tissue. For instance, if using a sleeve 22 having an open end, an obturator may provide a sharp tip.
- the obturator 24 is inserted into the sleeve 22 and the combination is guided by the track 98 to a proper orientation until an accurate depth is reached as set by the depth stop 26. Once fully inserted, the depth stop 26 prevents over-insertion.
- the sleeve 22 advantageously latches to the track 98 and/or the depth stop 26 to prevent inadvertent retraction, such as when the obturator 24 is withdrawn, and pressure is received from the breast tissue or later when a probe 100 of the MRI biopsy device 14 is withdrawn from the sleeve 22.
- imagable materials of the sleeve 22 and/or obturator 24, perhaps comprising or including marker material, enhance the ability to confirm the location of the sleeve 22 and its sleeve side aperture 102 as positioned for subsequent biopsy samples.
- the patient is removed from the MRI machine by retracting the gantry and the holstered MRI biopsy device 14 is brought to the localization fixture 16.
- a protective cap (not shown) is removed from the probe 100 of the MRI biopsy device 14 and the obturator 24 is removed from the sleeve 22.
- Mounting of the holster 44 to the track 98 is shown in FIGS. 2 and 3, wherein the holster 44 and MRI biopsy device 14 combination slide onto the track 98 that has been positioned at a certain location with respect to the pedestal 86 and lateral assembly 84.
- the sleeve 22 and probe 100 may advantageously visually and mechanically orient a probe side aperture 104 of the probe 100 with the sleeve side aperture 102, as well as forming a gas seal.
- the holster 44 and/or the probe 100 may latch onto the track 98 or sleeve 22 to confirm full insertion and prevent over-insertion and inadvertent retraction.
- the holster 44 allows an MRI biopsy device 14 intended for handheld use to have sufficient support in its attachment to the localization fixture 16 to accurately maintain its position and to avoid or minimize loads carried by the probe 100.
- the MRI biopsy system 10 may take tissue samples by activating a cutter mechanism in conjunction with vacuum assist, withdrawing the cutter and withdrawing a tissue sample, the latter perhaps also with vacuum assist.
- the probe 100/sleeve 22 combination are capable of manual, or perhaps automatic, rotation to a desired angle with respect to their longitudinal axis for additional samples or additional samples may be taken at the current orientation by further resorting to vacuum assist.
- the cutter is then advanced to close the probe side aperture 104 and the holster 44 is withdrawn from the localization fixture 16, thereby removing the probe 100 from the sleeve 22.
- Additional steps or combinations of steps may be performed at this point such as using the probe 100, a specialized obturator 24 (e.g., stylet), or merely the sleeve 22 to guide various agents to the surgical site of the biopsy. Examples include draining fluids, inserting anesthetic agents, inserting hemostatic agents, insufflating with pneumatic pressure and inserting a marker for subsequently locating the site of the biopsy, or other diagnostic or therapeutic procedures.
- the patient is then typically drawn back into the MRI machine bore for reimaging to confirm removal of at least a portion of the suspicious lesion and possibly placement of a marker.
- the sleeve 22 is sealed with the obturator or stylet 24.
- the localization fixture 16 is removed, the patient bandaged and removed from the gantry, and the disposable portions of the MRI biopsy system 10 disposed of as medical waste.
- the single targeting rail 98 facilitates sequential mounting of separate components. First the depth stop 26, then the sleeve 22 (as in FIG. 1), and then the biopsy tool 14 is slid onto the single targeting rail 98. Alternatively as depicted in FIGS. 2-3, the single targeting rail 98 may receive the depth stop 26 and then an MRI biopsy device 14 is used without a separate sleeve 22. The maximum depth of penetration into the patient's breast is preset by the location of the depth stop 26 on the single targeting rail 98.
- An engagement mechanism between the holster 44 and the single targeting rail 98 (not shown) and/or an engagement mechanism formed by a catch, depicted as an upwardly projecting pin 110, on an upper rail-gripping arm 112 of the depth stop 26 and a downwardly spring-biased rocker latch 114 that snaps onto the upwardly projecting pin 110, preventing inadvertent retraction of the MRI biopsy device 14.
- the holster 44 may be disengaged by downward pressure on a proximal actuating arm 116 of the rocker latch 114.
- the single targeting rail 98 may be longitudinally sized to be proximally extending sufficient that the MRI biopsy device 14 engages the single targeting rail 98 prior to the probe 100 contacting the patient's skin.
- the single targeting rail 98 is also sized to not extend proximally so far as to preclude use in a closed bore MRI machine (not shown).
- Such a MRI biopsy system 10 is believed to minimize the procedure turnaround time to less than 45 minutes as described above.
- a radiologist may position the probe 100 accurately to within 2 mm (5 mm maximum) of the lesion center. Further, the radiologist may maximize access to both breasts (left or right) during a procedure (both sides of the table) with minimal repositioning of the patient.
- a minimal amount of force to penetrate tissue is required, such as less than 4 lbs.
- the depth stop 26 serves to prevent overshooting, features for repositioning the depth stop 26 prior to further insertion of the probe 100 allow clinical flexibility in targeting another location. Orthogonal Targeting And Biopsy Rails ("Cradle").
- an alternative guidance assembly 200 for the MRI biopsy system 10 incorporates a cradle 202 that attaches to a targeting rail 204 and provides a biopsy rail 206 for supporting the MRI biopsy device, both rails 204, 206 aligned to the Z axis.
- the targeting rail 204 is attached to the positioning pillar 86 (not shown in FIG. 4) and vertically adjusted to a desired Y-position.
- a circular attachment point 208 may form a rotational engagement to the positional pedestal 86 to allow an angled targeting guide.
- a lateral face 210 of the targeting rail 204 includes an upper flange 212 and a lower flange 214 each having an L-shaped cross section for slidingly receiving a sleeve mount 216.
- Vertical rows of laterally projecting ridges 218 in each flange 212, 214 serve as a locking surface for the sleeve mount 216.
- a side channel 220 is recessed therein.
- the sleeve mount 216 guides a sleeve 222 by having its sleeve hub 224 proximally received in a hub receptacle 225 of the sleeve mount 216 and distally positioned and constrained by a depth stop 226.
- the depth stop 226 includes a slide member 228 that engages the side channel 220.
- a depth stop housing 230 attaches thereto, terminating in a reticule 232.
- a locking lever 234 is vertically pinned within a distally open recess (not shown) defined in the depth stop 226 with a lateral portion 236 spring biased away therefrom such that distally projecting feet 238 pivot against and engage the ridges 218, especially against a proximal movement. Depressing the lateral portion 236 proximally against the distally open recess of the depth stop housing 230 releases the distally projecting feet 238 to allow repositioning the depth stop 226 distally.
- An axis of penetration of the biopsy device 10 is aligned with the axes defined by the targeting rail 204 and the biopsy rail 206, which are laterally and vertically orthogonally offset therefrom, respectively. Extending a horizontal plane from the targeting rail 204 and extending a vertical plane from the biopsy rail 206 intersect at a common centerline that is the axis of penetration. Having the biopsy rail 206 vertically aligned and parallel to the axis of penetration advantageously provides support for the weight of the biopsy device 14 with a minimum of torsion loads that may otherwise create deflections of an inserted distal end.
- a bottom dovetail channel 240 in the targeting rail 204 receives a top dovetail extension 242 on the cradle 202, which is slid therein. It should be appreciated that mounting is shown herein on the right side of the positioning pedestal 86 when viewed proximally, but that the guidance assembly 200 advantageously comprises symmetric parts that allow mounting and use on either side of the positioning pedestal 86 to increase flexibility in positioning the probe 100.
- a horizontal base 244 of the cradle 202 forms the biopsy rail 206 as a biopsy guide channel 246 flanked by a first and second pair of monocle receptacles 248, 250 so that a pair of locking hooks 252 on a monocle 254 may be inserted in either pair of monocle receptacles 248, 250, depending on which is closer to the patient.
- the cradle may be directly attached to the positioning pedestal 86 (not shown).
- the cradle 202 is mechanically robust and can support the gross weight of the MRI biopsy device 14. Since the MRI biopsy device 14 does not share the cradle 202, the cradle 202 may be optimized to support the MRI biopsy device 14 when either shallow or deep lesions need to be accessed.
- a guide bushing 256 inserted in a monocle reticule 258 guides a marking instrument and/or a scoring scalpel (not shown) as an initial step in locating and preparing an insertion point.
- the monocle 254 may be removed thereafter or left in place to guide the sleeve 222 in addition to the reticule 232 of the depth stop 226, the latter which may also hold a guide bushing 260 for guiding the sleeve 222. Removing the guide bushings 256, 260 allows for the reticules 258, 232 of the monocle 254 and depth stop 226 to guide a larger component, such as a fiducial 262 used for locating a suspicious lesion relative to the guidance assembly 200.
- the alignment of the sleeve 222 is maintained by first passing through the hub receptacle 225 of the sleeve mount 216, which receives the sleeve hub 224.
- the sleeve 222 has an open ended shaft 266 for receiving an obturator 268 that includes a piercing tip (e.g., flat blade) 270 at a distal end of solid obturator shaft 272.
- a beveled recess 276 into the solid obturator shaft 272 is aligned with a sleeve side aperture 278 of the sleeve 222, and thus ultimately of the probe 100 (FIGS. 1-3).
- the materials of the obturator 268 may be selected to aid in locating the sleeve side aperture 276 of the sleeve 222, which otherwise may be more difficult to visualize and locate in an MRI scan slice.
- the sleeve hub 224 has its proximal cylindrical edge 280 attached to a guidance thumbwheel 282 that proximally extends from the hub receptacle 225 of the sleeve mount 216 for rotating the sleeve 222 to position its sleeve side aperture 278 with reference to a visual mark, depicted as a locking slot 284, on the thumbwheel 282 corresponding thereto.
- the thumbwheel 282 includes a central through hole 286 sealed by a wiper seal 288 and a duckbill seal 290 trapped between the thumbwheel 282 and the proximal cylindrical edge 280 of the sleeve hub 224.
- a stylet 298 may be inserted into the sleeve 222 so that a proximally presented hose nib 300 of the stylet 298 may be used to insufflate the surgical site or used for other purposes such as draining bodily fluids or inserting therapeutic or diagnostic agents through a stylet shaft 302 of the stylet 298 to a stylet side aperture 304 that is aligned with the side aperture 278 of the sleeve 222.
- the stylet 298 also includes a locking tab 306.
- the sleeve mount 216 includes a downwardly spring-biased rocker latch 308 that snaps onto a ramped catch 310 on the depth stop 226, preventing inadvertent retraction of the sleeve 222.
- the sleeve mount 216 may be disengaged by downward pressure on a proximal actuating arm 312 of the rocker latch 308.
- An upwardly spring-based rocker latch 314 attached to the bottom of the sleeve mount 216 similarly engages the depth stop 226.
- the sleeve mount 216 may be distally advanced without overshooting and subsequently be held in place when removing implements therefrom such as the obturator 268, stylet 298, and MRI biopsy device 14.
- FIG. 5 another alternative depth guidance assembly 400 for the MRI biopsy system 10 of FIG. 1 advantageously integrates a sleeve mount 402 with a depth stop second rail 404.
- a depth stop guide tab 406 of the guidance assembly 400 is sized to slide into a tracking lateral channel 408 of a cradle 410.
- Depth measurement indicia 412 (FIG. 5) on the guide tab 406 assist in prepositioning a sleeve block 414 prior to insertion.
- a locking actuator 416 on a proximal end of the depth stop second rail 404 is rotated 90 degrees clockwise as viewed proximally to disengage a threaded or ridged side 418 of the depth stop second rail 404 laterally out of threaded engagement with an inner recess 420 of the sleeve block 414 (FIG. 5B) thereby allowing gross adjustment. Then the sleeve block 414 is locked onto the depth stop second rail 404 by rotating the locking actuator 416 counterclockwise (FIGS.
- the sleeve block 414 includes upper and lower gripping flanges 422, 424 that lock onto upper and lower guides 426, 428 (FIG. 5B) that define the tracking lateral channel 408, providing a robust support for the sleeve 222 (FIGS. 5C, 5D).
- a depth guidance assembly 400a further includes a flip monocle 450 with a proximal flag 452 that allows rotating a monocle shaft 454, which snaps into a top surface of a cradle or carriage 456, to ultimately rotate a monocle reticule 458 either laterally or up and out of the way.
- the cradle 456 is attached in this version to a gripping clasp 460 that vertically slides up a proximal vertical portion 462 of a pedestal or pillar 464 that has a blunted arrowhead horizontal cross section.
- a sleeve block 470 advantageously includes a backside lever 472 allowing insertion of a sleeve 474 and obturator 476 by pushing in a manner familiar to surgeons with typical needle biopsies.
- a forefinger depresses a side lever 477 that unlocks the sleeve block 470 and allows the slide block 470 to be distally pushed forward by a thumb. Releasing the side lever 477 allows the slide block 470 to lock into place. Removal is performed by depressing the backside lever 472 in a similar manner. Since the flat of the thumb is easily able to exert a force of 5 lbs, this is a more comfortable method for the surgeon than using other contact points on the hand.
- the obturator 476 is released in this version by lifting up a cap lever 478 that rotates 180 degrees from a pivot point 480 at one side of an obturator cap 482 that is easy to grip as compared to small rings as typically used.
- FIG. 7 yet another depth guidance assembly 500 with a sleeve block 502 having a guide tab 504 spaced apart from a depth stop second rail 506 by a beam 508 is shown.
- the sleeve block 502 includes a proximal half cylindrical recess 510 that receives an outward portion of the depth stop second rail 506.
- a distal half cylindrical recess 512 which is aligned with the proximal half cylindrical recess 510, has an increased inner diameter to receive a resilient knuckle 513 that is shaped as a cylindrical bushing with a longitudinal gap 514.
- upper and lower ends 516, 518 of the knuckle 513 (FIG.
- the knuckle 513 allows mediation of the sleeve block 502 as depicted in FIGS. 8-9.
- the sleeve block 502 and depth stop second rail 506 form a worm gear engagement such that rotating a screw handle 520 at a proximal end of the depth stop second rail 506 may be used for fine adjustment of the depth position of the sleeve block 502, and thus a sleeve mount 522 and sleeve 222.
- the initial depth is set outside the MRI machine ("coil") (not shown) with the knuckle 513 and the depth stop second rail (“screw") 506 for fine control.
- the sleeve block 502 is locked to the primary targeting rail (not shown), the screw 506 is backed out the desired additional depth, as depicted in FIGS. 10, 10A, and then the sleeve block 502 is pushed into the new depth with a single motion until the screw handle 520 hits the back of the primary targeting rail.
- an additional depth guidance assembly 600 includes a depth stop second rail (screw) 602 held parallel to a guide tab 604 that slides into the primary targeting rail 204 (FIGS. 11, 11A, 12, 13, 13A) that is set at a desired Y-axis position.
- a rough adjust button 608 is presented toward the back (distal) side of a sleeve block 610 so as to discourage its use after insertion into the primary targeting rail 204 (FIG. 11). Depressing the rough adjust button 608 proximally translates a locking plate 612 (FIG. 11B) having a distally projecting and inwardly biased spring finger 614, drawing the latter out of engagement with outer threads 616 on the depth stop second rail 602 allowing rough adjustment.
- the locking plate 612 is pinched between rectangular upper and lower structures 618, 620, which are attached at their more vertically displaced distal corners 622, 624 and proximal corners 626, 628 respectively.
- a top release lever arm 630 has a downwardly arcing distal portion 632 that is attached to the rectangular upper structure 618 between distal and proximal corners 622, 626, and is biased upwardly and spaced away from an upper lateral cylindrical structure 634 attached to the proximal corner 626.
- a proximally and upwardly extending handle portion 636 of the top release lever arm 630 when pushed inwardly (down), causes the arcing distal portion 632 to contact the upper lateral cylindrical structure 634, prying the rectangular upper structure 618 away from the locking plate 612.
- a bottom release lever arm 640 has an upwardly arcing distal portion 642 that is attached to the rectangular lower structure 620 between distal and proximal corners 624, 628, is biased downwardly and spaced away from a lower lateral cylindrical structure 644 attached to the proximal corner 628.
- a proximally and downwardly extending handle portion 646 of the bottom release lever arm 640 when pushed inwardly (up), causes the arcing distal portion 642 to contact the lower lateral cylindrical structure 644, prying the rectangular lower structure 620 away from the locking plate 612.
- a vertical leaf spring 652 (FIG. 11B), held at its upper and lower ends 654, 656 in the sleeve block 610, is allowed to bias a proximal end 658 of the locking plate 612 and thus the rough adjust button 608 distally. Thereby, the sleeve block 610 is locked again to the depth stop second rail 602.
- the rough adjust button 608 is depressed to allow positioning the sleeve block 610 when detached from the primary targeting rail 204 (FIG. 11).
- the release buttons 650 are depressed to lock the screve block 610 to the depth stop second rail (screw) 602 and to deactivate the rough adjust button 608.
- a screw handle 660 is turned at the proximal end of the depth stop second rail 602 is refine the position.
- the depth guidance assembly 600 is attached by sliding the guide tab 604 into the primary targeting rail 204 (FIGS. 12, 13).
- the sleeve block 610 is locked to the primary targeting rail 204, the screw 602 is backed out the desired additional depth, and then the sleeve block 610 is pushed into the new depth with a single motion until the screw handle 660 hits the back of the primary targeting rail 204.
- a telescoping depth guidance assembly 700 for the MRI biopsy system 10 of FIG. 1 includes a depth stop second rail 702, particularly including a depth stop screw 704 in sliding engagement to an intermediate telescoping rail 706.
- the latter slidingly engages the primary targeting rail 204 (FIG. 14A) prior to the sleeve 222 and obturator 268 piercing tissue even with a most distal depth setting.
- a proximal lock 707 (FIG. 14) on the intermediate telescoping rail 706 engages the primary targeting rail 204..
- Rough adjustment of the depth setting is made by depressing a rough adjust button 708 on a distal side of a sleeve block 710, which disengages the sleeve block 710 from worm gear engagement to the depth stop screw 704.
- a ratchet mechanism formed between the sleeve block 710 and the intermediate telescoping rail 706 prevents the sleeve block 710 from being retracted unless a back button 714 is depressed.
- the telescoping depth guide assembly 700 is advanced toward the cradle 202 and primary targeting rail 204.
- the intermediate telescoping rail 706 is thus guided before the piercing tip 270 passes through the monocle 254 to pierce tissue until the proximal lock 707.
- a rear depth stop tab 716 on the depth stop screw 704 is advanced until at its distal-most position, thereby distally advancing the sleeve block 710, sleeve 222, and obturator 268 to a first depth position.
- the rear depth stop tab 716 In response to a desired adjustment after reimaging or to take a second biopsy at an adjusted position that is at a greater depth into the breast, the rear depth stop tab 716 is rotated counterclockwise (or clockwise if the screw thread is reversed when viewed from behind) as depicted in FIG. 18 to slightly retract the depth stop screw 704.
- the sleeve block 710 is engaged to the intermediate telescoping rail 706 and remains in place.
- the rear depth stop tab 716 is pressed, advancing the depth stop screw 704, sleeve lock 712, sleeve 222, and obturator 268 to a second depth.
- the proximal lock is depressed slightly and the sleeve block is pulled back. This exposes the screw 704, and it can be rotated to set the new, shallower depth.
- the telescoping depth guide assembly 700 is removed from the primary targeting rail 204 by depressing the proximal lock 707, which releases the intermediate telescoping rail 706.
- an alternative telescoping depth guidance assembly 800 includes a primary targeting rail 802 (FIGS. 21, 23) that includes a guide tab surface 804 that slides within a leftward channel 806 (FIGS. 23, 23A) of an intermediate telescoping rail 808 (FIG. 22).
- the guide tab surface 804 has a proximally positioned pawl recess 810 that engages a spring biased pawl 812 that pivots within a laterally open aperture 814 (FIGS. 24, 24A) through a proximal end of the intermediate telescoping rail 808.
- a tooth 816 on a leftward engaging surface 820 of a gripping channel 822 of a sleeve mount 824 (FIGS.
- a rightward distal tip 828 of the pawl 812 is rotated clockwise when viewed from the top disengaging the tooth 816 from the pawl aperture 814 allowing the sleeve mount 824 to slide distally over the intermediate telescoping rail 808 to the desired depth.
- retraction of the sleeve mount 824 causes the tooth 816 to abut the rightward distal tip 828 of the pawl 812, urging further clockwise rotation when viewed from above, disengaging the catch tip 826 from the pawl recess 810 and positioning the pawl 812 as depicted in FIG. [[23B]] 22 whereupon sleeve mount 824 binds to the unlocked intermediate telescoping rail 808 and draws both off of the primary targeting rail 802.
- a dispensing housing partially enshrouds a penetrating member (e.g., detachable probe, close ended sleeve, open ended sleeve with penetrating obturator) while allowing access to a depth stop for presetting a desired depth of penetration.
- a dispensing actuator e.g., plunger
- the dispensing housing is depicted as a laterally guided biopsy cassette 900 that integrates a glide sleeve 902 that acts as an intermediate telescoping rail to mount to a primary targeting rail 802 (FIG. 21).
- the glide sleeve 902 also encompasses a glide plunger 904 that in turn encompasses the tissue penetrating components (i.e., a sleeve 906 and an obturator 908) as a preassembled unit.
- the glide plunger 904 includes a proximal plunge handle 910 attached to a plunge tube (or arm) 912 having an inner longitudinal slot 914 (FIGS.
- the glide sleeve 902 has an outer longitudinal slot 918 with edges sized and contoured to engage the primary targeting rail 802 along a left side thereof registered to the inner longitudinal slot 914, with the outer longitudinal slot 918 having a distal end communicating with a open distal end 920 of the glide sleeve 902.
- a glide sleeve finger 922 is attached just proximal to the outer longitudinal slot 918 of the glide sleeve 902 and extends distally down a large portion of its length. A proximal portion of the glide sleeve finger 922 thickens inwardly abruptly to form a glide sleeve knuckle 923.
- a longitudinally positionable plunger arm depicted as a finger grasp 924, has distally projecting upper and lower flanges 926, 928 with respective upper and lower outwardly projecting obturator release buttons 930, 932 that slide in upper and lower longitudinal slots 934, 936 in the plunge tube 912. Proximal ends of each flange 926, 928 curl inward and back distally forming upper and lower spring ends 938, 940 attached to a finger grasp base 942, thereby exerting an outward bias on the flanges 926, 928.
- the flanges 926, 928 grip an obturator hub 944 of the obturator 908.
- a sleeve mount depicted as an obturator guide 946, includes a cylindrical portion 948 that encompasses a sleeve hub 950 of the sleeve 906.
- Upper and lower guide arms 952, 954 (FIG. 28, 28C) engage the outer longitudinal slot 918 and pass to either side of the glide sleeve finger 922.
- a depth stop ring 956 is initially proximally positioned on the plunge tube 912 next to the glide handle 910.
- the laterally guided biopsy cassette 900 is in its preassembled state as removed from packaging for use.
- the glide sleeve 902 is to be advanced distally, as depicted by arrow 958, resulting in the telescoped state of FIG. 29B.
- the upper and lower outwardly projecting obturator release buttons 930, 932 are depressed to release from a proximal position and are slid forward distally until locked at a distal position as depicted in FIG. 29C.
- the finger grasp 942 advances the obturator 908, obturator guide 946, and sleeve 906 out of the plunger tube 912 and into the advanced glide sleeve 902.
- FIG. 29A the laterally guided biopsy cassette 900 is in its preassembled state as removed from packaging for use.
- the glide sleeve 902 is to be advanced distally, as depicted by arrow 958, resulting in the telescoped state of FIG. 29B.
- the depth stop ring 956 has been advanced along the plunge tube 912 with reference to measurement indicia thereon to a desired depth. Then, the laterally guided biopsy cassette 900 is engaged to a primary targeting rail 802. Specifically, the glide sleeve finger 922 slides therein until the glide sleeve knuckle 923 is reached.
- the plunge handle 910 is rotated counterclockwise 90 degrees when viewed proximally. Thereby, the finger grasp 942 is also rotated by the plunge tube 912 until aligned with the outer longitudinal slot 918 of the glide sleeve 902 to unlock the glide plunger 904. In FIG. 29F, the glide plunger 904 is thus distally advanced into the glide sleeve 902.
- the obturator guide 946 is advanced so that its upper and lower flanges 926, 928 engage the primary targeting rail 802.
- the sleeve 906 and obturator 908 penetrate tissue until the depth stop ring 956 encounters the glide sleeve 902 preventing further advancement.
- a biopsy cassette 1000 has a transparent glide sleeve 1002 that holds the depth guidance assembly 600 of FIGS. 11-13.
- a right-side slot 1005 runs down the length of a plunger tube 1004 with a protruding slide control 1006 at a proximal position. Coupled to the slide control 1006 is an obturator 1008 that is retracted into the plunger tube 1004 so as to protect its piercing tip from inadvertent contact.
- the slide control 1006 acts as a longitudinally positionable plunger arm that has been distally advanced inserting the obturator 1008 into the sleeve 222.
- the depth may be preset on the depth guidance assembly 600 through use of the rough adjust button 608 and fine tuning screw handle 660 that are exposed by the transparent glide sleeve 1002.
- the biopsy cassette 1000 is aligned to the primary targeting rail 802.
- the biopsy cassette 1000 has advanced until the depth guidance assembly 600 is fully engaged to the primary targeting rail 802.
- the biopsy cassette 1000 is retracted, leaving the depth guidance assembly 600 in place.
- a fiduciary marker separate from the lateral plate may be positioned to a specific point on the exterior of the patient's breast as part of a guidance assembly.
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Abstract
Description
- The present application claims the benefit of U.S. provisional patent application entitled "MRI BIOPSY DEVICE" to Hughes et al., Ser. No. 60/573,510, filed on 21 May 2004 and is related to the nonprovisional patent application entitled "LOCALIZATION MECHANISM FOR AN MRI COMPATIBLE BIOPSY DEVICE" to Hibner et al., Serial No. 10/171,330, filed on 23 April 2002, and published on 23 October 2003 as Pub. No. US 2003/0199785, the disclosure of both are hereby incorporated by reference in their entirety.
- The present invention relates, in general, to a method of imaging assisted tissue sampling and, more particularly, to an improved method for positioning a biopsy probe with respect to a magnetic resonance imaging (MRI) breast coil for acquiring subcutaneous biopsies and for removing lesions.
- Recently, core biopsy devices have been combined with imaging technology to better target a lesion in breast tissues. One such commercially available product is marketed under the trademark name MAMMOTOME™, by Ethicon Endo-Surgery, Inc. An embodiment of such a device is described in U.S. Patent No. 5,526,822 issued to Burbank, et al., on June 18, 1996, and is hereby incorporated herein by reference. Its handle receives mechanical and electrical power as well as vacuum assist from a remotely positioned control module that is spaced away from the high magnetic field of a Magnetic Resonance Imaging (MRI) machine.
- As seen from that reference, the instrument is a type of image-guided, percutaneous coring, breast biopsy instrument. It is vacuum-assisted, and some of the steps for retrieving the tissue samples have been automated. The physician uses this device to capture "actively" (using the vacuum) the tissue prior to severing it from the body. This allows the sampling of tissues of varying hardness. In addition, a side opening aperture is used, avoiding having to thrust into a lesion, which may tend to push the mass away, cause a track metastasis, or cause a hematoma that, with residual contrast agent circulating therein, may mimic enhancement in a suspicious lesion. The side aperture may be rotated about a longitudinal axis of the probe, thereby allowing multiple tissue samples without having to otherwise reposition the probe. These features allow for substantial sampling of large lesions and complete removal of small ones.
- In the aforementioned Pub. No. US 2003/0199785 to Hibner et al., localization fixtures are described that are attachable to a breast coil. These localization fixtures aid in accurately positioning the probe to a location of a suspicious lesion within breast tissue. In particular, the X-Y-Z Cartesian coordinates of a suspicious lesion are referenced to a fiduciary marker in the localization fixture. Humanly visible measurement guides for each axis then allow the probe to be correspondingly positioned after a patient has been withdrawn from a closed bore MRI machine without the need for imaging the probe during insertion. In addition, the localization fixture enables use of a detachable probe of an MRI biopsy device. Thus, during subsequent reimaging of the probe, a handle of the MRI biopsy device may be detached, as may be necessary within the close confines of a closed bore MRI machine. When the handle is attached to the probe, various support structures of the localization fixture are described that support the extended length of the handle.
- While a localization fixture used with a detachable MRI biopsy probe has a number of advantages, it would be desirable to incorporate additional features that further assist in accurately positioning the probe, preventing over insertion or inadvertent retraction of the probe, and supporting the MRI biopsy device.
- Consequently, a significant need exists for an improved localization fixture for use in an MRI guided biopsy procedure that assists in locating a suspicious lesion and for accurately performing a biopsy or complete removal of the suspicious lesion, even in conjunction with the close confines of closed bore MRI machines.
- The invention overcomes the above-noted and other deficiencies of the prior art by providing a localization and guidance assembly that interfaces an MRI biopsy device to a breast coil to accurately position and maintain a probe at a desired position in a patient's breast for performing biopsy and related diagnostic and therapeutic procedures, and especially for making a single insertion and taking multiple biopsy samples.
- In one aspect of the invention, a guide element is selectively positioned parallel to a desired axis of penetration into a patient. A mount movingly engages the guide element so that a penetrating portion of a biopsy instrument is supported along the axis of penetration during insertion into the patient. A depth limiting member, attached to a selected one of the mount and guide element, is advantageously adjusted prior to full insertion to arrest distal movement of the mount when the penetrating portion reaches a desired depth.
- In another aspect of the invention, a localization fixture compressively localizes a patient's breast, while a pedestal is laterally positioned to support the guide element, which is also vertically adjusted on the pedestal into parallel alignment with the desired axis of penetration. Thereby, accurate insertion and greater hands free maintenance of position is achieved for breast biopsy procedures.
- In yet another aspect of the invention, a method of guiding a penetrating portion of a biopsy device includes aligning a guide element parallel to and offset from a designated axis of penetration into a patient. Setting a depth limit for penetration prior to penetrating tissue assures that overshooting the intended target is avoided. Then slidingly engaging the penetrating portion of the biopsy device to the guide element effects penetration of the patient along the designated axis of penetration until arrested by the depth limit setting.
- The present invention shall be made apparent from the accompanying drawings and the description thereof.
- The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the present invention.
- FIGURE 1 is a perspective disassembled view of a Magnetic Resonance Imaging (MRI) biopsy system incorporating an elemental version of a guidance apparatus including a single targeting rail for positioning a probe depth-stop and guiding a biopsy device;
- FIGURE 2 is a disassembled perspective view of a localization fixture, and a depth stop and MRI biopsy device of the elemental version of the MRI biopsy system of FIG. 1;
- FIGURE 3 is a perspective view of a positioning pedestal and a single targeting rail of the elemental version of the MRI biopsy system of FIG. 1 after positioning of the depth stop and MRI biopsy device;
- FIGURE 4 is a perspective disassembled view of an alternative guidance assembly for the MRI biopsy system of FIG. 1, incorporating orthogonally targeting and biopsy support rails ("cradle");
- FIGURE 5 is a perspective view of a cradle engaging a depth stop second rail, depicted as locked, of another alternative guidance assembly for the MRI biopsy system of FIG. 1;
- FIGURE 5A is a perspective view of the depth stop second rail of FIG. 5, depicted as locked;
- FIGURE 5B is a proximal view in elevation of the cradle and depth stop second rail taken in cross section along lines 5B-5B of FIG. 5;
- FIGURE 5C is a top view of the depth stop second rail of FIG. 5 aligned for insertion into the cradle for insertion of a sleeve;
- FIGURE 5D is a top view of the depth stop second rail of FIG. 5C after insertion into the cradle;
- FIGURE 6 is a top view of an alternative depth guidance assembly with a flip monocle and a side lever that unlocks a
sleeve block 470 for the MRI biopsy system of FIG. 1; - FIGURE 7 is a top right perspective view of an additional depth guidance assembly with a knuckle mediated rough adjust for the MRI biopsy system of FIG. 1;
- FIGURE 8 is a left, proximal perspective view of a mediated knuckle and sleeve block with a guide tab and depth-stop second rail (screw) shown in phantom of the depth guidance assembly of FIG. 7;
- FIGURE 9 is a top, left, and distal perspective view of the depth guidance assembly of FIG. 7;
- FIGURE 10 is a top, proximal, perspective view of the depth guidance assembly of FIG. 7, distally adjusted for additional depth;
- FIGURE 10A is a top view of the depth guidance assembly of FIG. 10 in longitudinal cross section;
- FIGURE 11 is a top, proximal and right perspective view of another depth guidance assembly having rough adjust and release buttons shown detached from a primary targeting rail for the MRI biopsy system of FIG. 1;
- FIGURE 11A is a top view in longitudinal cross section of the depth guidance assembly with rough adjust and release buttons of FIG. 11 fully inserted into a targeting single rail;
- FIGURE 11B is a left, proximal and perspective view of a sleeve block cutaway along lines 11A-11A of the depth guidance assembly of FIG. 11;
- FIGURE 12 is a top, proximal and right perspective view of the depth guidance assembly of FIG. 11 after being partially inserted into the primary targeting rail;
- FIGURE 13 is a top, proximal and right perspective view of the depth guidance assembly of FIG. 11 after being fully inserted into the primary targeting rail;
- FIGURE 13A is a top view of the depth guidance assembly of FIG. 13 taken in cross section along lines 13A-13A;
- FIGURE 14 is a top, proximal and right perspective view of a telescoping depth guidance assembly with a sleeve and obturator for the MRI biopsy system of FIG. 1 engaged to a sleeve block;
- FIGURE 14A is a top view of the telescoping depth guidance assembly of FIG. 14 mounted in a targeting rail of the MRI biopsy system of FIG. 1;
- FIGURE 15 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 14 detached from a targeting rail and cradle;
- FIGURE 15A is a top view of the telescoping depth guidance assembly and targeting rail of FIG. 15;
- FIGURE 16 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 14 being guided by the targeting rail as the sleeve passes through a monocle on the cradle;
- FIGURE 16A is a top view of the telescoping depth guidance assembly of FIG. 16;
- FIGURE 17 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 16 after reaching a first targeted depth;
- FIGURE 17A is a top view of the telescoping guidance assembly of FIG. 17;
- FIGURE 18 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 17 after unscrewing the depth stop second rail;
- FIGURE 19 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 18 after distally inserting to the adjusted depth;
- FIGURE 20 is a top, proximal and right perspective view of the telescoping depth guidance assembly of FIG. 19 after depressing a proximal lock release and partially extracting the depth guidance assembly from the targeting rail and cradle;
- FIGURE 21 is a top, proximal and right perspective view of an alternative primary targeting rail including a pawl recess for the MRI biopsy system of FIG. 1;
- FIGURE 22 is a perspective view of an alternative intermediate telescoping rail with a pawl in a second position;
- FIGURE 23 is a perspective view of the alternative intermediate telescoping rail of FIG. 22, with a pawl in a third position, attached to the primary targeting rail of FIG. 21;
- FIGURE 23A is a perspective view of the alternative intermediate telescoping rail of FIG 22, with a pawl in a first position;
- FIGURE 24 is a right side view in elevation of a proximal portion of the intermediate telescoping rail of FIG. 23;
- FIGURE 24A is a top view of the proximal portion of the intermediate telescoping rail of FIG. 24 taken in cross section through the pawl, pawl recess of the primary targeting rail, and pawl aperture in the intermediate telescoping rail;
- FIGURE 25 is a perspective view of a sleeve block with locking tooth for the alternative intermediate telescoping rail of FIG. 22;
- FIGURE 26 is an aft view in elevation of the primary targeting rail and intermediate telescoping rail of FIG. 23;
- FIGURE 27 is a left side view in elevation of the proximal portion of the intermediate telescoping rail;
- FIGURE 28 is a perspective view of a laterally guided biopsy cassette for the MRI biopsy system of FIG. 1;
- FIGURE 29 is a left side view in elevation of a disassembled laterally guided biopsy cassette of FIG. 28;
- FIGURE 28B is a left side view in elevation of the laterally guided biopsy cassette of FIG. 28 taken along a longitudinal centerline;
- FIGURE 28C is a top view of the laterally guided biopsy cassette of FIG. 28 taken along the longitudinal centerline;
- FIGURE 29A is a perspective view of the laterally guided biopsy cassette of FIG. 28 in an initial condition with the glide sleeve retracted over the plunger handle;
- FIGURE 29B is a perspective view of the laterally guided biopsy cassette of FIG. 29A after distally advancing the glide sleeve from the plunger handle;
- FIGURE 29C is a perspective view of the laterally guided biopsy cassette of FIG. 29B after depressing the release buttons and advancing a sleeve and obturator out of a plunger tube but within the confines of the glide sleeve;
- FIGURE 29D is a perspective view of the laterally guided biopsy cassette of FIG. 29C as the glide sleeve and an obturator guide are engaged to a targeting rail of a localization fixture;
- FIGURE 29E is a perspective view of the plunger tube being unlocked from the glide sleeve;
- FIGURE 29F is a perspective view of the plunger tube being advanced into the glide sleeve, causing penetration of the sleeve and obturator, allowing thereafter retraction of the glide sleeve from the targeting rail;
- FIGURE 30A is a perspective view of an alternative biopsy cassette containing the depth guidance assembly with rough adjust and release buttons of FIG. 11 with a sleeve mounted thereto and an obturator retracted into a plunge tube of the alternative biopsy cassette;
- FIGURE 30B is a perspective view of the alternative biopsy cassette of FIG. 30A after a slide control is advanced on the plunge tube to insert the obturator into the sleeve;
- FIGURE 30C is a perspective view of the alternative biopsy cassette being engaged onto a targeting rail and cassette of a localization fixture;
- FIGURE 30D is a perspective view of the alternative biopsy cassette fully engaged onto the targeting rail and cassette of a localization fixture; and
- FIGURE 30E is a perspective of the alternative biopsy cassette removed from the targeting rail and cassette of a localization fixture leaving the depth guidance assembly thereon.
- Turning to the Drawings, wherein like numerals denote like components throughout the several views, in FIG. 1, a Magnetic Resonance Imaging (MRI)
biopsy system 10 includes a guide element and an adjustable depth stop that assists a surgeon in inserting a biopsy probe along a desired trajectory without overshooting. In particular, a guide element is adjustably positioned to be parallel to an axis of penetration, which in turn is aimed to pass through an insertion point to a surgical site inside of the patient, typically where a suspicious lesion has been imaged. With a biopsy device detached from the guide element, a depth stop is adjustably set to a desired penetration depth. Then a mount that supports at least the penetrating portion of the biopsy device is guided by the guide element as tissue of the patient is penetrated until the depth stop arrests further movement of the mount relative to the guide element. Thereby, accurate insertion of the penetrating portion without overshooting is enabled. - The
MRI biopsy system 10 includes acontrol module 12 that typically is placed outside of a shielded room containing an MRI machine (not shown) or at least spaced away to mitigate detrimental interaction with its strong magnetic field and/or sensitive radio frequency (RF) signal detection antennas. Thecontrol module 12 controls and powers anMRI biopsy device 14 that is compatible for use in close proximity to the MRI machine. An example of anMRI biopsy device 14 is the afore-mentioned MAMMOTOME™ instrument. TheMRI biopsy device 14 is accurately positioned by alocalization fixture 16 that is attached to abreast coil 18, which in turn supports a patient (not shown). Examples of commercially available breast coils 18 include the BIOPSY BREAST COIL MODEL BBC by MRI DEVICES CORPORATION of Waukesha WI. Aguidance assembly 20, and in particular asleeve 22, advantageously attaches to thelocalization fixture 16 to increase imaging and therapeutic flexibility and accuracy in conjunction with selective use of theMRI biopsy device 14 at particular parts of the procedure. Theguidance assembly 20 may include one ormore obturators 24 with one depicted that seals thesleeve 22 during insertion and during subsequent portions of the procedure in which theMRI biopsy device 14 is not inserted therein. Adepth stop 26 is provided for use with thelocalization fixture 16 to advantageously prevent over-insertion of thesleeve 22, inadvertent retraction of thesleeve 22 and/or to enhance accurate placement of thesleeve 22 to a desired location along the Z-Axis. - For convenience, herein a convention is used for locating a suspicious lesion by Cartesian coordinates within breast tissue referenced to the
localization fixture 16 and to thereafter position an instrument (e.g., sleeve 22) to this location without necessarily continuously imaging the region. As will be described in greater detail below, a perforated barrier that is compressed along an outside side of the breast, with respect to a medial plane of the chest of the patient, defines an X-Y plane, with the X-axis being vertical (sagittal) with respect to a standing patient and which corresponds to a left to right axis as viewed by a clinician facing the externally exposed portion of thelocalization fixture 16. A fiduciary marker (not shown) attached to or positioned relative to thelocalization fixture 16 proximate to the patient's skin defines the origin of this plane. Perpendicular to this X-Y plane extending toward the medial side of the breast is the Z-axis, which typically corresponds to the orientation and depth of insertion of theMRI biopsy device 14, although it should be appreciated that variations may allow insertion at an angle to this Z-axis. Thus, for clarity, the term Z-axis may be used interchangeably with "axis of penetration", although the latter may or may not be orthogonal to the spatial coordinates used to locate an insertion point on the patient. - Separating the tracking rail that supports a mount / depth stop from a biopsy rail that supports the weight of the biopsy device advantageously reduces interference between the various components, allowing a sequence of operation wherein certain components may be selectively installed and removed without interfering with other components..
- In use, the
MRI biopsy system 10 is prepared for use by placing acable management spool 30 upon a cable management attachment saddle 32 that projects from a side of thecontrol module 12. Wound upon thecable management spool 30 is a pairedelectrical cable 34 andmechanical cable 36 for communicating control signals and cutter rotation/advancement motions respectively. In particular, electrical andmechanical cables mechanical ports 40, 42 in thecontrol module 12 and another end connected to aholster 44 that receives theMRI biopsy device 14. AnMRI docking cup 46, which may hold theholster 44 when not in use, is hooked to thecontrol module 12 by a dockingstation mounting bracket 48. - An
interface lock box 50 mounted to a wall provides atether 52 to a lockout port 54 on thecontrol module 12. Thetether 52 is advantageously uniquely terminated and of short length to preclude inadvertent positioning of thecontrol module 12 too close to the MRI machine. An in-line enclosure 56 may advantageously register thetether 52,electrical cable 34 andmechanical cable 36 to theirrespective ports 54, 42, 44 on thecontrol module 12. Aremote keypad 58 may be distally connected to theelectrical cable 34 to enhance clinician control of theMRI biopsy device 14, especially when controls on theMRI biopsy device 14 itself are not readily accessible after insertion into thelocalization fixture 16. - Vacuum assist is provided by a
first vacuum line 60 that connects between thecontrol module 12 and anoutlet port 62 of avacuum canister 64 that catches liquid and solid debris. Atubing kit 66 completes the pneumatic communication between thecontrol module 12 and theMRI biopsy device 14. In particular, asecond vacuum line 68 is connected to aninlet port 70 of thevacuum canister 64. Thesecond vacuum line 68 divides into twovacuum lines MRI biopsy device 14. With theMRI biopsy device 14 installed in theholster 44, thecontrol module 12 performs a functional check. Saline is manually injected intobiopsy device 14 to serve as a lubricant and to assist in achieving a vacuum seal. Thecontrol module 12 actuates a cutter mechanism (not shown) in theMRI biopsy device 14, monitoring full travel. - The portion of the
MRI biopsy system 10 used near the MRI machine is also assembled. The generally knownbreast coil 18 is placed upon a gantry of the MRI machine, along with other body support pads (not shown). Thelocalization fixture 16, which is attached within a recess on either lateral side of thebreast coil 18 to access a patient's breast that is pendulously exposed therein, includes a horizontalmedial plate 80, areusable base assembly 82, alateral assembly 84, and apositioning pedestal 86. Thelocalization fixture 16 is also assembled with a disposablemedial fence 90 and a lateral window (or perforated plate) 92. - The
base assembly 82 is placed within a selected lateral recess of thebreast coil 18. Themedial fence 90 attaches to a medial edge of themedial plate 80, aligned vertically approximately along a longitudinal axis of thebreast coil 18 under an inner edge of a selectedbreast aperture 94 that receives a patient's breast. With the patient thus positioned and the outer area of the breast sterilized, thelateral window 92 is downwardly slid into a three-sided frame guide 96 of thelateral assembly 84, which in turn is placed upon themedical plate 80. Thebase assembly 82 andlateral assembly 84 are moved with respect to one another along the Z-axis to compress the patient's breast between themedial fence 90 and thelateral window 92. A mechanism formed between thelateral assembly 84,base assembly 82, andmedial plate 80 maintains this compression. - Contrast agent may be injected into the patient to enhance the imaging. The gantry is advanced into the MRI machine bore to image the
localization fixture 16 and breast tissue. The fiduciary marker on thelateral window 92 is located and designated as the origin of the X-Y-Z coordinates. Then a suspicious lesion is located within the image and a point thereon selected to determine its location relative to the origin. It should be appreciated that orienting the X-Y-Z axis of an initial scan may be facilitated by having thelateral window 92 formed of an imagable material, thus presenting an X-Y plane in addition to the origin point of the fiduciary marker. With the target location determined, the gantry is withdrawn from the MRI machine bore. - The
positioning pedestal 86 is slidably engaged along the X-axis of thelateral assembly 84 and defines a vertical guide for positioning a single targeting rail ("track") 98 at a selected Y-axis coordinate. Thetrack 98 in turn provides a depth guide along the Z-axis for positioning thedepth stop 26 and theholster 44 at a desired Z-axis coordinate. Thedepth stop 26 is latched onto thetrack 98. Thereafter, a marking instrument (not shown) may be inserted through thedepth stop 26 to mark the insertion point on the breast. Thereafter, thedepth stop 26 is moved out of the way. Anesthesia is injected superficially, following by a scoring cut at the marked location and a subsequent injection of anesthesia more deeply into the scored cut. Thedepth stop 26 is then repositioned on thetrack 98 to the desired Z-axis coordinate reference. - The
obturator 24 is inserted into the sleeve and may be positioned to close any apertures of the sleeve 22 (side and/or distal end) to present a closed surface to the breast tissue. The obturator may also be shaped or formed to enhance the visibility of the aperture location. One or the other of theobturator 24 andsleeve 22 presents a sharp tip (not shown) to penetrate breast tissue. For instance, if using asleeve 22 having an open end, an obturator may provide a sharp tip. - The
obturator 24 is inserted into thesleeve 22 and the combination is guided by thetrack 98 to a proper orientation until an accurate depth is reached as set by thedepth stop 26. Once fully inserted, thedepth stop 26 prevents over-insertion. Thesleeve 22 advantageously latches to thetrack 98 and/or thedepth stop 26 to prevent inadvertent retraction, such as when theobturator 24 is withdrawn, and pressure is received from the breast tissue or later when aprobe 100 of theMRI biopsy device 14 is withdrawn from thesleeve 22. - The gantry is moved into the MRI machine bore and the patient is imaged again to confirm placement of the
sleeve 22 with respect to the suspicious lesion. Advantageously, imagable materials of thesleeve 22 and/orobturator 24, perhaps comprising or including marker material, enhance the ability to confirm the location of thesleeve 22 and itssleeve side aperture 102 as positioned for subsequent biopsy samples. - The patient is removed from the MRI machine by retracting the gantry and the holstered
MRI biopsy device 14 is brought to thelocalization fixture 16. A protective cap (not shown) is removed from theprobe 100 of theMRI biopsy device 14 and theobturator 24 is removed from thesleeve 22. Mounting of theholster 44 to thetrack 98 is shown in FIGS. 2 and 3, wherein theholster 44 andMRI biopsy device 14 combination slide onto thetrack 98 that has been positioned at a certain location with respect to thepedestal 86 andlateral assembly 84. Features of thesleeve 22 and probe 100 may advantageously visually and mechanically orient aprobe side aperture 104 of theprobe 100 with thesleeve side aperture 102, as well as forming a gas seal. Advantageously, theholster 44 and/or theprobe 100 may latch onto thetrack 98 orsleeve 22 to confirm full insertion and prevent over-insertion and inadvertent retraction. Theholster 44 allows anMRI biopsy device 14 intended for handheld use to have sufficient support in its attachment to thelocalization fixture 16 to accurately maintain its position and to avoid or minimize loads carried by theprobe 100. - Thereafter, the
MRI biopsy system 10 may take tissue samples by activating a cutter mechanism in conjunction with vacuum assist, withdrawing the cutter and withdrawing a tissue sample, the latter perhaps also with vacuum assist. Theprobe 100/sleeve 22 combination are capable of manual, or perhaps automatic, rotation to a desired angle with respect to their longitudinal axis for additional samples or additional samples may be taken at the current orientation by further resorting to vacuum assist. The cutter is then advanced to close theprobe side aperture 104 and theholster 44 is withdrawn from thelocalization fixture 16, thereby removing theprobe 100 from thesleeve 22. - Additional steps or combinations of steps may be performed at this point such as using the
probe 100, a specialized obturator 24 (e.g., stylet), or merely thesleeve 22 to guide various agents to the surgical site of the biopsy. Examples include draining fluids, inserting anesthetic agents, inserting hemostatic agents, insufflating with pneumatic pressure and inserting a marker for subsequently locating the site of the biopsy, or other diagnostic or therapeutic procedures. - The patient is then typically drawn back into the MRI machine bore for reimaging to confirm removal of at least a portion of the suspicious lesion and possibly placement of a marker. During this reimaging, the
sleeve 22 is sealed with the obturator orstylet 24. Thereafter, thelocalization fixture 16 is removed, the patient bandaged and removed from the gantry, and the disposable portions of theMRI biopsy system 10 disposed of as medical waste. - With particular reference to FIGS. 2-3, the single targeting
rail 98 facilitates sequential mounting of separate components. First thedepth stop 26, then the sleeve 22 (as in FIG. 1), and then thebiopsy tool 14 is slid onto the single targetingrail 98. Alternatively as depicted in FIGS. 2-3, the single targetingrail 98 may receive thedepth stop 26 and then anMRI biopsy device 14 is used without aseparate sleeve 22. The maximum depth of penetration into the patient's breast is preset by the location of thedepth stop 26 on the single targetingrail 98. An engagement mechanism between theholster 44 and the single targeting rail 98 (not shown) and/or an engagement mechanism formed by a catch, depicted as an upwardly projectingpin 110, on an upper rail-grippingarm 112 of thedepth stop 26 and a downwardly spring-biasedrocker latch 114 that snaps onto the upwardly projectingpin 110, preventing inadvertent retraction of theMRI biopsy device 14. Theholster 44 may be disengaged by downward pressure on aproximal actuating arm 116 of therocker latch 114. - The single targeting
rail 98 may be longitudinally sized to be proximally extending sufficient that theMRI biopsy device 14 engages the single targetingrail 98 prior to theprobe 100 contacting the patient's skin. The single targetingrail 98 is also sized to not extend proximally so far as to preclude use in a closed bore MRI machine (not shown). Such aMRI biopsy system 10 is believed to minimize the procedure turnaround time to less than 45 minutes as described above. Yet with this expeditious turnaround, a radiologist may position theprobe 100 accurately to within 2 mm (5 mm maximum) of the lesion center. Further, the radiologist may maximize access to both breasts (left or right) during a procedure (both sides of the table) with minimal repositioning of the patient. Further, a minimal amount of force to penetrate tissue is required, such as less than 4 lbs. Although thedepth stop 26 serves to prevent overshooting, features for repositioning thedepth stop 26 prior to further insertion of theprobe 100 allow clinical flexibility in targeting another location. Orthogonal Targeting And Biopsy Rails ("Cradle"). - In FIG. 4, an
alternative guidance assembly 200 for theMRI biopsy system 10 incorporates acradle 202 that attaches to a targetingrail 204 and provides abiopsy rail 206 for supporting the MRI biopsy device, bothrails rail 204 is attached to the positioning pillar 86 (not shown in FIG. 4) and vertically adjusted to a desired Y-position. Acircular attachment point 208 may form a rotational engagement to thepositional pedestal 86 to allow an angled targeting guide. - A
lateral face 210 of the targetingrail 204 includes anupper flange 212 and a lower flange 214 each having an L-shaped cross section for slidingly receiving asleeve mount 216. Vertical rows of laterally projectingridges 218 in eachflange 212, 214 serve as a locking surface for thesleeve mount 216. Between theflanges 212, 214, aside channel 220 is recessed therein. Thesleeve mount 216 guides asleeve 222 by having itssleeve hub 224 proximally received in ahub receptacle 225 of thesleeve mount 216 and distally positioned and constrained by adepth stop 226. - The
depth stop 226 includes a slide member 228 that engages theside channel 220. Adepth stop housing 230 attaches thereto, terminating in areticule 232. A lockinglever 234 is vertically pinned within a distally open recess (not shown) defined in the depth stop 226 with alateral portion 236 spring biased away therefrom such that distally projectingfeet 238 pivot against and engage theridges 218, especially against a proximal movement. Depressing thelateral portion 236 proximally against the distally open recess of thedepth stop housing 230 releases thedistally projecting feet 238 to allow repositioning thedepth stop 226 distally. - An axis of penetration of the
biopsy device 10 is aligned with the axes defined by the targetingrail 204 and thebiopsy rail 206, which are laterally and vertically orthogonally offset therefrom, respectively. Extending a horizontal plane from the targetingrail 204 and extending a vertical plane from thebiopsy rail 206 intersect at a common centerline that is the axis of penetration. Having thebiopsy rail 206 vertically aligned and parallel to the axis of penetration advantageously provides support for the weight of thebiopsy device 14 with a minimum of torsion loads that may otherwise create deflections of an inserted distal end. Thereby, even for a relatively heavy and elongated device, positioning and maintaining its distal end is achievable within 5 mm, and even 2 mm, of a desired insertion point. Thereby, a "hands free" procedure may be performed, avoiding the inconvenience or the impracticabilitxis of penetration in the illustrative version may be replaced by one vertically displaced above the axis of penetration. In particular, having a cradle that may be engaged to either side of the targetingrail 204 would provide further vertical symmetry to take full advantage of the space afforded by thebreast coil 18. - While a "hands free" capability is advantageous for a single insertion/multiple sample biopsy device, it should be appreciated that such penetration guidance with a preset depth stop as described herein has application to even light-weight biopsy devices that employ a core needle biopsy with a single insertion per single sample. In particular, correct placement need not be conditional on continuous imaging. Over penetration during insertion and inadvertent displacement is avoided when hands are free.
- A
bottom dovetail channel 240 in the targetingrail 204 receives atop dovetail extension 242 on thecradle 202, which is slid therein. It should be appreciated that mounting is shown herein on the right side of thepositioning pedestal 86 when viewed proximally, but that theguidance assembly 200 advantageously comprises symmetric parts that allow mounting and use on either side of thepositioning pedestal 86 to increase flexibility in positioning theprobe 100. Thus, ahorizontal base 244 of thecradle 202 forms thebiopsy rail 206 as a biopsy guide channel 246 flanked by a first and second pair ofmonocle receptacles monocle 254 may be inserted in either pair ofmonocle receptacles cradle 202 to the targetingrail 204 as depicted, the cradle may be directly attached to the positioning pedestal 86 (not shown). Thecradle 202 is mechanically robust and can support the gross weight of theMRI biopsy device 14. Since theMRI biopsy device 14 does not share thecradle 202, thecradle 202 may be optimized to support theMRI biopsy device 14 when either shallow or deep lesions need to be accessed. - A
guide bushing 256 inserted in amonocle reticule 258 guides a marking instrument and/or a scoring scalpel (not shown) as an initial step in locating and preparing an insertion point. Themonocle 254 may be removed thereafter or left in place to guide thesleeve 222 in addition to thereticule 232 of thedepth stop 226, the latter which may also hold aguide bushing 260 for guiding thesleeve 222. Removing theguide bushings reticules monocle 254 and depth stop 226 to guide a larger component, such as a fiducial 262 used for locating a suspicious lesion relative to theguidance assembly 200. - The alignment of the
sleeve 222 is maintained by first passing through thehub receptacle 225 of thesleeve mount 216, which receives thesleeve hub 224. In the illustrative version, thesleeve 222 has an open endedshaft 266 for receiving anobturator 268 that includes a piercing tip (e.g., flat blade) 270 at a distal end ofsolid obturator shaft 272. Abeveled recess 276 into thesolid obturator shaft 272 is aligned with asleeve side aperture 278 of thesleeve 222, and thus ultimately of the probe 100 (FIGS. 1-3). The materials of theobturator 268 may be selected to aid in locating thesleeve side aperture 276 of thesleeve 222, which otherwise may be more difficult to visualize and locate in an MRI scan slice. - The
sleeve hub 224 has its proximalcylindrical edge 280 attached to aguidance thumbwheel 282 that proximally extends from thehub receptacle 225 of thesleeve mount 216 for rotating thesleeve 222 to position itssleeve side aperture 278 with reference to a visual mark, depicted as alocking slot 284, on thethumbwheel 282 corresponding thereto. Thethumbwheel 282 includes a central throughhole 286 sealed by awiper seal 288 and aduckbill seal 290 trapped between thethumbwheel 282 and the proximalcylindrical edge 280 of thesleeve hub 224. Thus insertion of theobturator 268, which includes alocking tab 292 that enters thelocking slot 284, closes the central throughhole 286 and forms a dynamic seal against thewiper seal 288. - After removing the
obturator 268, astylet 298 may be inserted into thesleeve 222 so that a proximally presentedhose nib 300 of thestylet 298 may be used to insufflate the surgical site or used for other purposes such as draining bodily fluids or inserting therapeutic or diagnostic agents through astylet shaft 302 of thestylet 298 to astylet side aperture 304 that is aligned with theside aperture 278 of thesleeve 222. Thestylet 298 also includes alocking tab 306. - The
sleeve mount 216 includes a downwardly spring-biasedrocker latch 308 that snaps onto a rampedcatch 310 on thedepth stop 226, preventing inadvertent retraction of thesleeve 222. Thesleeve mount 216 may be disengaged by downward pressure on aproximal actuating arm 312 of therocker latch 308. An upwardly spring-basedrocker latch 314 attached to the bottom of thesleeve mount 216 similarly engages thedepth stop 226. Thus, after thedepth stop 226 is set on the targetingrail 204 to a desired depth of insertion, thesleeve mount 216 may be distally advanced without overshooting and subsequently be held in place when removing implements therefrom such as theobturator 268,stylet 298, andMRI biopsy device 14. - In FIG. 5, another alternative
depth guidance assembly 400 for theMRI biopsy system 10 of FIG. 1 advantageously integrates asleeve mount 402 with a depth stopsecond rail 404. A depthstop guide tab 406 of theguidance assembly 400 is sized to slide into a trackinglateral channel 408 of acradle 410. Depth measurement indicia 412 (FIG. 5) on theguide tab 406 assist in prepositioning asleeve block 414 prior to insertion. In FIG. 5A, a lockingactuator 416 on a proximal end of the depth stopsecond rail 404 is rotated 90 degrees clockwise as viewed proximally to disengage a threaded or ridgedside 418 of the depth stopsecond rail 404 laterally out of threaded engagement with aninner recess 420 of the sleeve block 414 (FIG. 5B) thereby allowing gross adjustment. Then thesleeve block 414 is locked onto the depth stopsecond rail 404 by rotating the lockingactuator 416 counterclockwise (FIGS. 5, 5B, 5C) and then inserting theguide tab 406 into the trackinglateral channel 408 of thecradle 410 until further insertion is blocked by lockingactuator 416 abutting the cradle 410 (FIG. 5D). Thesleeve block 414 includes upper and lowergripping flanges lateral channel 408, providing a robust support for the sleeve 222 (FIGS. 5C, 5D). - In FIG. 6, a
depth guidance assembly 400a further includes aflip monocle 450 with aproximal flag 452 that allows rotating amonocle shaft 454, which snaps into a top surface of a cradle orcarriage 456, to ultimately rotate amonocle reticule 458 either laterally or up and out of the way. Thecradle 456 is attached in this version to agripping clasp 460 that vertically slides up a proximalvertical portion 462 of a pedestal orpillar 464 that has a blunted arrowhead horizontal cross section. Asleeve block 470 advantageously includes abackside lever 472 allowing insertion of asleeve 474 andobturator 476 by pushing in a manner familiar to surgeons with typical needle biopsies. A forefinger depresses aside lever 477 that unlocks thesleeve block 470 and allows theslide block 470 to be distally pushed forward by a thumb. Releasing theside lever 477 allows theslide block 470 to lock into place. Removal is performed by depressing thebackside lever 472 in a similar manner. Since the flat of the thumb is easily able to exert a force of 5 lbs, this is a more comfortable method for the surgeon than using other contact points on the hand. Theobturator 476 is released in this version by lifting up acap lever 478 that rotates 180 degrees from a pivot point 480 at one side of an obturator cap 482 that is easy to grip as compared to small rings as typically used. - In FIG. 7, yet another
depth guidance assembly 500 with asleeve block 502 having aguide tab 504 spaced apart from a depth stopsecond rail 506 by abeam 508 is shown. In FIG. 8, thesleeve block 502 includes a proximal halfcylindrical recess 510 that receives an outward portion of the depth stopsecond rail 506. A distal halfcylindrical recess 512, which is aligned with the proximal halfcylindrical recess 510, has an increased inner diameter to receive aresilient knuckle 513 that is shaped as a cylindrical bushing with alongitudinal gap 514. Thus, upper and lower ends 516, 518 of the knuckle 513 (FIG. 8) opposingly grip the depth stopsecond rail 506 and abut thebeam 508. Yet, theknuckle 513 allows mediation of thesleeve block 502 as depicted in FIGS. 8-9. When unmediated as in FIG. 7, thesleeve block 502 and depth stopsecond rail 506 form a worm gear engagement such that rotating ascrew handle 520 at a proximal end of the depth stopsecond rail 506 may be used for fine adjustment of the depth position of thesleeve block 502, and thus asleeve mount 522 andsleeve 222. In particular, the initial depth is set outside the MRI machine ("coil") (not shown) with theknuckle 513 and the depth stop second rail ("screw") 506 for fine control. If additional depth is desired, thesleeve block 502 is locked to the primary targeting rail (not shown), thescrew 506 is backed out the desired additional depth, as depicted in FIGS. 10, 10A, and then thesleeve block 502 is pushed into the new depth with a single motion until the screw handle 520 hits the back of the primary targeting rail.
Second Rail Sleeve Mount With Rough Adjust And Release Buttons. - In FIGS. 11, 11A, 11B, 12, 13 and 13A, yet an additional
depth guidance assembly 600 includes a depth stop second rail (screw) 602 held parallel to aguide tab 604 that slides into the primary targeting rail 204 (FIGS. 11, 11A, 12, 13, 13A) that is set at a desired Y-axis position. A rough adjustbutton 608 is presented toward the back (distal) side of asleeve block 610 so as to discourage its use after insertion into the primary targeting rail 204 (FIG. 11). Depressing the rough adjustbutton 608 proximally translates a locking plate 612 (FIG. 11B) having a distally projecting and inwardly biasedspring finger 614, drawing the latter out of engagement withouter threads 616 on the depth stopsecond rail 602 allowing rough adjustment. - With particular reference to FIG. 11B, the locking
plate 612 is pinched between rectangular upper andlower structures 618, 620, which are attached at their more vertically displaceddistal corners proximal corners release lever arm 630 has a downwardly arcingdistal portion 632 that is attached to the rectangular upper structure 618 between distal andproximal corners cylindrical structure 634 attached to theproximal corner 626. A proximally and upwardly extendinghandle portion 636 of the toprelease lever arm 630, when pushed inwardly (down), causes the arcingdistal portion 632 to contact the upper lateralcylindrical structure 634, prying the rectangular upper structure 618 away from the lockingplate 612. Similarly, a bottomrelease lever arm 640 has an upwardly arcingdistal portion 642 that is attached to the rectangularlower structure 620 between distal andproximal corners cylindrical structure 644 attached to theproximal corner 628. A proximally and downwardly extendinghandle portion 646 of the bottomrelease lever arm 640, when pushed inwardly (up), causes the arcingdistal portion 642 to contact the lower lateralcylindrical structure 644, prying the rectangularlower structure 620 away from the lockingplate 612. With both top and bottomrelease lever arms sleeve block 610, is allowed to bias aproximal end 658 of thelocking plate 612 and thus the rough adjustbutton 608 distally. Thereby, thesleeve block 610 is locked again to the depth stopsecond rail 602. - In use, the rough adjust
button 608 is depressed to allow positioning thesleeve block 610 when detached from the primary targeting rail 204 (FIG. 11). When close to the desired position, therelease buttons 650 are depressed to lock thescreve block 610 to the depth stop second rail (screw) 602 and to deactivate the rough adjustbutton 608. Then ascrew handle 660 is turned at the proximal end of the depth stopsecond rail 602 is refine the position. Additionally, thedepth guidance assembly 600 is attached by sliding theguide tab 604 into the primary targeting rail 204 (FIGS. 12, 13). If additional depth is desired, thesleeve block 610 is locked to the primary targetingrail 204, thescrew 602 is backed out the desired additional depth, and then thesleeve block 610 is pushed into the new depth with a single motion until the screw handle 660 hits the back of the primary targetingrail 204. - In FIGS. 14-20, a telescoping
depth guidance assembly 700 for theMRI biopsy system 10 of FIG. 1 includes a depth stopsecond rail 702, particularly including adepth stop screw 704 in sliding engagement to anintermediate telescoping rail 706. The latter slidingly engages the primary targeting rail 204 (FIG. 14A) prior to thesleeve 222 andobturator 268 piercing tissue even with a most distal depth setting. At full insertion (FIG. 14A), a proximal lock 707 (FIG. 14) on theintermediate telescoping rail 706 engages the primary targetingrail 204.. Rough adjustment of the depth setting is made by depressing a rough adjustbutton 708 on a distal side of asleeve block 710, which disengages thesleeve block 710 from worm gear engagement to thedepth stop screw 704. A ratchet mechanism formed between thesleeve block 710 and theintermediate telescoping rail 706 prevents thesleeve block 710 from being retracted unless aback button 714 is depressed. - In use, in FIGS. 15, 15A, the telescoping
depth guide assembly 700 is advanced toward thecradle 202 and primary targetingrail 204. In Figs. 16, 16A, theintermediate telescoping rail 706 is thus guided before the piercingtip 270 passes through themonocle 254 to pierce tissue until theproximal lock 707. In FIGS. 17, 17A, a reardepth stop tab 716 on thedepth stop screw 704 is advanced until at its distal-most position, thereby distally advancing thesleeve block 710,sleeve 222, andobturator 268 to a first depth position. In response to a desired adjustment after reimaging or to take a second biopsy at an adjusted position that is at a greater depth into the breast, the reardepth stop tab 716 is rotated counterclockwise (or clockwise if the screw thread is reversed when viewed from behind) as depicted in FIG. 18 to slightly retract thedepth stop screw 704. Thesleeve block 710, however, is engaged to theintermediate telescoping rail 706 and remains in place. In FIG. 19, the reardepth stop tab 716 is pressed, advancing thedepth stop screw 704, sleeve lock 712,sleeve 222, andobturator 268 to a second depth. If the initial depth is too great, the proximal lock is depressed slightly and the sleeve block is pulled back. This exposes thescrew 704, and it can be rotated to set the new, shallower depth. In FIG. 20, the telescopingdepth guide assembly 700 is removed from the primary targetingrail 204 by depressing theproximal lock 707, which releases theintermediate telescoping rail 706. - In FIGS. 21-27, an alternative telescoping
depth guidance assembly 800 includes a primary targeting rail 802 (FIGS. 21, 23) that includes aguide tab surface 804 that slides within a leftward channel 806 (FIGS. 23, 23A) of an intermediate telescoping rail 808 (FIG. 22). Theguide tab surface 804 has a proximally positionedpawl recess 810 that engages a springbiased pawl 812 that pivots within a laterally open aperture 814 (FIGS. 24, 24A) through a proximal end of theintermediate telescoping rail 808. Atooth 816 on a leftwardengaging surface 820 of agripping channel 822 of a sleeve mount 824 (FIGS. 25, 26) initially engages thepawl aperture 814, forcing the springbiased pawl 812 to rotate counterclockwise when viewed from above (FIG. 23A). As theintermediate telescoping rail 808 is slid distally onto theguide tab surface 804, a catch tip 826 (FIG. 24A) of the springbiased pawl 812 is urged into thepawl recess 810 preventing proximal retraction. Constraints on the proximal end of theleftward channel 806 of theintermediate telescoping rail 808 prevent further distal movement. A rightwarddistal tip 828 of thepawl 812 is rotated clockwise when viewed from the top disengaging thetooth 816 from thepawl aperture 814 allowing thesleeve mount 824 to slide distally over theintermediate telescoping rail 808 to the desired depth. Upon completion, retraction of thesleeve mount 824 causes thetooth 816 to abut the rightwarddistal tip 828 of thepawl 812, urging further clockwise rotation when viewed from above, disengaging thecatch tip 826 from thepawl recess 810 and positioning thepawl 812 as depicted in FIG. [[23B]] 22 whereuponsleeve mount 824 binds to the unlockedintermediate telescoping rail 808 and draws both off of the primary targetingrail 802. - The above-described versions of the
MRI biopsy system 10 advantageously enable remotely setting of a depth stop prior to engaging abiopsy device 14 with alocalization fixture 16 to penetrate tissue. It would be desirable that the various components be assembled in a fashion that reduces separate sterile packaging, reduces the likelihood of damage due to contact with the sharp penetrating tip of a sleeve or obturator, and simplifies assembly and use. To that end, a dispensing housing partially enshrouds a penetrating member (e.g., detachable probe, close ended sleeve, open ended sleeve with penetrating obturator) while allowing access to a depth stop for presetting a desired depth of penetration. A dispensing actuator (e.g., plunger) is thereafter employed to effect engagement and penetration with the simultaneous removal of the dispensing housing from the penetrating member. - In FIGS. 28, 28A-C, 29A-29F, the dispensing housing is depicted as a laterally guided
biopsy cassette 900 that integrates aglide sleeve 902 that acts as an intermediate telescoping rail to mount to a primary targeting rail 802 (FIG. 21). Theglide sleeve 902 also encompasses aglide plunger 904 that in turn encompasses the tissue penetrating components (i.e., asleeve 906 and an obturator 908) as a preassembled unit. In particular, theglide plunger 904 includes a proximal plunge handle 910 attached to a plunge tube (or arm) 912 having an inner longitudinal slot 914 (FIGS. 28, 28C) along a left side of theplunge tube 912 with a distal end of thelongitudinal slot 914 communicating with a distal open end 916 of theplunge tube 912. Theglide sleeve 902 has an outerlongitudinal slot 918 with edges sized and contoured to engage the primary targetingrail 802 along a left side thereof registered to the innerlongitudinal slot 914, with the outerlongitudinal slot 918 having a distal end communicating with a opendistal end 920 of theglide sleeve 902. Aglide sleeve finger 922 is attached just proximal to the outerlongitudinal slot 918 of theglide sleeve 902 and extends distally down a large portion of its length. A proximal portion of theglide sleeve finger 922 thickens inwardly abruptly to form aglide sleeve knuckle 923. - With particular reference to FIGS. 28, 28A, 28B, a longitudinally positionable plunger arm, depicted as a
finger grasp 924, has distally projecting upper andlower flanges obturator release buttons longitudinal slots plunge tube 912. Proximal ends of eachflange finger grasp base 942, thereby exerting an outward bias on theflanges flanges obturator hub 944 of theobturator 908. A sleeve mount, depicted as anobturator guide 946, includes acylindrical portion 948 that encompasses asleeve hub 950 of thesleeve 906. Upper andlower guide arms 952, 954 (FIG. 28, 28C) engage the outerlongitudinal slot 918 and pass to either side of theglide sleeve finger 922. Adepth stop ring 956 is initially proximally positioned on theplunge tube 912 next to theglide handle 910. - In use, in FIG. 29A, the laterally guided
biopsy cassette 900 is in its preassembled state as removed from packaging for use. Theglide sleeve 902 is to be advanced distally, as depicted byarrow 958, resulting in the telescoped state of FIG. 29B. Then the upper and lower outwardly projectingobturator release buttons finger grasp 942 advances theobturator 908,obturator guide 946, andsleeve 906 out of theplunger tube 912 and into theadvanced glide sleeve 902. In FIG. 29D, thedepth stop ring 956 has been advanced along theplunge tube 912 with reference to measurement indicia thereon to a desired depth. Then, the laterally guidedbiopsy cassette 900 is engaged to aprimary targeting rail 802. Specifically, theglide sleeve finger 922 slides therein until theglide sleeve knuckle 923 is reached. In FIG. 29E, theplunge handle 910 is rotated counterclockwise 90 degrees when viewed proximally. Thereby, thefinger grasp 942 is also rotated by theplunge tube 912 until aligned with the outerlongitudinal slot 918 of theglide sleeve 902 to unlock theglide plunger 904. In FIG. 29F, theglide plunger 904 is thus distally advanced into theglide sleeve 902. Theobturator guide 946 is advanced so that its upper andlower flanges rail 802. Thesleeve 906 andobturator 908 penetrate tissue until thedepth stop ring 956 encounters theglide sleeve 902 preventing further advancement. - In FIGS. 30A-30F, a
biopsy cassette 1000 has atransparent glide sleeve 1002 that holds thedepth guidance assembly 600 of FIGS. 11-13. In FIG. 30A, a right-side slot 1005 runs down the length of aplunger tube 1004 with a protrudingslide control 1006 at a proximal position. Coupled to theslide control 1006 is anobturator 1008 that is retracted into theplunger tube 1004 so as to protect its piercing tip from inadvertent contact. Thus, in FIG. 30B, theslide control 1006 acts as a longitudinally positionable plunger arm that has been distally advanced inserting theobturator 1008 into thesleeve 222. In addition, the depth may be preset on thedepth guidance assembly 600 through use of the rough adjustbutton 608 and fine tuning screw handle 660 that are exposed by thetransparent glide sleeve 1002. In FIG. 30C, thebiopsy cassette 1000 is aligned to the primary targetingrail 802. In FIG. 30D, thebiopsy cassette 1000 has advanced until thedepth guidance assembly 600 is fully engaged to the primary targetingrail 802. In FIG. 30E, thebiopsy cassette 1000 is retracted, leaving thedepth guidance assembly 600 in place. - While the present invention has been illustrated by description of several embodiments and while the illustrative embodiments have been described in considerable detail, it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications may readily appear to those skilled in the art. For example, other imaging modalities may benefit from aspects of the present invention. As another example, a fiduciary marker separate from the lateral plate may be positioned to a specific point on the exterior of the patient's breast as part of a guidance assembly.
- As an example, while the illustrative versions incorporate positioning and penetration guidance along Cartesian X-Y-Z coordinates, it should be appreciated that applications consistent with the present invention may utilize other adjustment schemes such as spherical, cylindrical or other coordinate systems. It should be noted that various versions described above allowed for rotation of the depth guidance member such that the axis of penetration was not solely in the Z-axis, orthogonal to the X-Y axis defined by the localization fixture. This capability to adjust the angle of penetration may be desirable in certain instances to penetrate into the patient to minimize tissue damage (e.g., minimize the length of the penetrated tissue), to obscure any scarring of the skin, to avoid certain tissues such as the chest wall, etc
- As another example, other types of biopsy devices may advantageously be guided during penetration. In U.S. Pat. Appln. Ser. No. 11/025,556 filed on 29 December 2004, entitled "CORE SAMPLING BIOPSY DEVIDE WITH SHORT COUPLED MRI-COMPATIBLE DRIVER" to John A. Hibner, et al., the disclosure of which is hereby incorporated by reference in its entirety, both a long-stroke and a short-stroke core biopsy are described.
- As another example, while many desirable features enable and enhance use in an MRI suite, applications consistent with the present invention may be employed with other imaging modalities (e.g., ultrasonic, CT, etc.).
Claims (12)
- An apparatus for use with a biopsy device in a medical procedure, comprising:a guide element selectively positioned parallel to a desired axis of penetration into a patient;a mount movingly engageable to the guide element and operably configured to support a penetrating portion of the biopsy device aligned to the axis of penetration during insertion; anda depth limiting member, attachable to a selected one of the mount and guide element, adjustable to arrest the movement of the mount at a predetermined depth of insertion.
- The apparatus of claim 1, wherein the depth limiting member attaches to the guide element corresponding to the predetermined depth of insertion.
- The apparatus of claim 2, wherein the depth limiting member includes a receptacle aligned with the axis of penetration operably configured to guide a distal end and to arrest a proximal end of the piercing portion of biopsy device.
- The apparatus of claim 3, wherein the mount comprises a holster supporting a handle portion of the biopsy device.
- The apparatus of claim 2, wherein the mount engages a proximal end of the penetrating portion, the depth limiting member registered to abut the mount to arrest movement thereof.
- The apparatus of claim 5, further comprising a locking mechanism operably configured to resist retraction of the mount from the guide element.
- The apparatus of claim 6, wherein the locking mechanism comprises a latch engageable between the mount and the depth limiting member.
- The apparatus of claim 1, further comprising a cradle coupled to the guide element and extending laterally and vertically offset from the axis of penetration.
- The apparatus of claim 8, wherein the cradle includes a biopsy guide vertically aligned with the axis of penetration and operably configured to movably engage a handle portion of the biopsy device.
- The apparatus of claim 9, wherein the cradle is vertically aligned below the axis of penetration.
- An apparatus for guiding insertion of a probe of a core biopsy device, the apparatus comprising:compressive members operably configured to localize the patient's breast;a laterally positionable pedestal;a guide element adjustably vertically positioned on the pedestal parallel to a desired axis of penetration into a patient;a mount movingly engageable to the guide element and operably configured to support a penetrating portion of the biopsy device aligned to the axis of penetration during insertion; anda depth limiting member, attachable to a selected one of the mount and guide element, adjustable to arrest the movement of the mount at a predetermined depth of insertion.
- A method of guiding a penetrating portion of a biopsy device, comprising:aligning a guide element parallel to and offset from a designated axis of penetration into a patient;setting a depth limit for penetration; andslidingly engaging the penetrating portion of the biopsy device to the guide element to effect penetration of the patient along the designated axis of penetration until arrested by the depth limit setting.
Priority Applications (1)
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EP08015872A EP2005908B1 (en) | 2004-05-21 | 2005-05-23 | MRI biopsy device |
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US573510P | 2004-05-21 | ||
US11/076,612 US7708751B2 (en) | 2004-05-21 | 2005-03-10 | MRI biopsy device |
US11/103,718 US7693567B2 (en) | 2004-05-21 | 2005-04-12 | MRI biopsy apparatus incorporating a sleeve and multi-function obturator |
US11/103,959 US7831290B2 (en) | 2004-05-21 | 2005-04-12 | MRI biopsy device localization fixture |
US103959 | 2005-04-12 | ||
US103718 | 2005-04-12 |
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EP08015872A Division EP2005908B1 (en) | 2004-05-21 | 2005-05-23 | MRI biopsy device |
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Also Published As
Publication number | Publication date |
---|---|
EP1761174A1 (en) | 2007-03-14 |
EP2005908A1 (en) | 2008-12-24 |
WO2005112778A1 (en) | 2005-12-01 |
DE602005017037D1 (en) | 2009-11-19 |
EP1604615B1 (en) | 2008-09-10 |
EP1761174B1 (en) | 2009-10-07 |
CA2569101A1 (en) | 2005-12-01 |
ES2313236T3 (en) | 2009-03-01 |
EP2005908B1 (en) | 2012-09-26 |
JP4860182B2 (en) | 2012-01-25 |
JP2005334644A (en) | 2005-12-08 |
CA2569101C (en) | 2013-07-16 |
DE602005009604D1 (en) | 2008-10-23 |
ES2332373T3 (en) | 2010-02-03 |
JP2005334643A (en) | 2005-12-08 |
JP2008500139A (en) | 2008-01-10 |
AU2005244978B2 (en) | 2011-10-06 |
JP2005334645A (en) | 2005-12-08 |
AU2005244978A1 (en) | 2005-12-01 |
ATE444712T1 (en) | 2009-10-15 |
JP4799905B2 (en) | 2011-10-26 |
JP4615565B2 (en) | 2011-01-19 |
JP5279983B2 (en) | 2013-09-04 |
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